History: A 56 yr old k/c/o CKD-5 on MHD thrice weekly with HTN presented to ED with SOB, drowsy, anasarca. He has missed his hemodialysis this week. BP-170/102 mmhg, P-84 bpm, Spo2 – 82% on RA (99% on NRBM 14/L O2), B\L crepts +nt. Serum K+ – 8.4 mmol/L. What’s the finding in ECG?
Answer: ECG shows sine wave appearance in severe hyperkalemia. Hyperkalaemia is defined as a serum potassium level of > 5.2 mmol/L. ECG changes generally do not manifest until there is a moderate degree of hyperkalaemia (≥ 6.0 mmol/L). The earliest manifestation of hyperkalaemia is an increase in T wave amplitude.
The patient was treated with 10% 10ml of IV calcium gluconate, nebulised with Salbutamol, 10 units of regular insulin IV combined with dextrose 50%, IV sodium bicarbonate 50 mEq and Inj. Furosemide 40mg IV. Emergent haemodialysis was initiated. Pt was shifted to ICU.